Predictors of Airway and Respiratory Adverse Events With Ketamine Sedation in the Emergency Department: An Individual-Patient Data Meta-analysis of 8,282 Children

Green, Steven M., Roback, Mark G., Krauss, Baruch, Brown, Lance, McGlone, Ray G., Agrawal, Dewesh, McKee, Michele, Weiss, Markus, Pitetti, Raymond D., Hostetler, Mark A., Wathen, Joe E., Treston, Greg, Garcia Pena, Barbara M., Gerber, Andreas C. and Losek, Joseph D. (2009) Predictors of Airway and Respiratory Adverse Events With Ketamine Sedation in the Emergency Department: An Individual-Patient Data Meta-analysis of 8,282 Children. Annals of Emergency Medicine, 54 2: 158-168. doi:10.1016/j.annemergmed.2008.12.011


Author Green, Steven M.
Roback, Mark G.
Krauss, Baruch
Brown, Lance
McGlone, Ray G.
Agrawal, Dewesh
McKee, Michele
Weiss, Markus
Pitetti, Raymond D.
Hostetler, Mark A.
Wathen, Joe E.
Treston, Greg
Garcia Pena, Barbara M.
Gerber, Andreas C.
Losek, Joseph D.
Title Predictors of Airway and Respiratory Adverse Events With Ketamine Sedation in the Emergency Department: An Individual-Patient Data Meta-analysis of 8,282 Children
Journal name Annals of Emergency Medicine   Check publisher's open access policy
ISSN 0196-0644
1097-6760
Publication date 2009-01-01
Year available 2009
Sub-type Article (original research)
DOI 10.1016/j.annemergmed.2008.12.011
Open Access Status
Volume 54
Issue 2
Start page 158
End page 168
Total pages 11
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Subject 2711 Emergency Medicine
Formatted abstract
Study objective: Although ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events.

Methods: We pooled individual-patient data from 32 ED studies and performed multiple logistic regressions to determine which clinical variables would predict airway and respiratory adverse events.

Results: In 8,282 pediatric ketamine sedations, the overall incidence of airway and respiratory adverse events was 3.9%, with the following significant independent predictors: younger than 2 years (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.47 to 2.72), aged 13 years or older (OR 2.72; 95% CI 1.97 to 3.75), high intravenous dosing (initial dose ≥2.5 mg/kg or total dose ≥5.0 mg/kg; OR 2.18; 95% CI 1.59 to 2.99), coadministered anticholinergic (OR 1.82; 95% CI 1.36 to 2.42), and coadministered benzodiazepine (OR 1.39; 95% CI 1.08 to 1.78). Variables without independent association included oropharyngeal procedures, underlying physical illness (American Society of Anesthesiologists class ≥3), and the choice of intravenous versus intramuscular route.

Conclusion: Risk factors that predict ketamine-associated airway and respiratory adverse events are high intravenous doses, administration to children younger than 2 years or aged 13 years or older, and the use of coadministered anticholinergics or benzodiazepines. 
Keyword Emergency Medicine
Emergency Medicine
EMERGENCY MEDICINE
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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